延迟脐带结扎对新生儿心血管稳定性和黄疸的影响

Effects of delayed cord ligation on cardiovascular stability and jaundice in neonates

目的分析延迟脐带结扎对足月新生儿的影响,为延迟断脐带结扎在临床的实施提供理论数据支持。方法选取2019年6至9月在延安大学附属医院足月顺娩的孕产妇及其新生儿100例为研究对象。根据新生儿完全娩出至脐带结扎的时间分为5组,即A组[即刻断脐(<30 s)]、B组(出生后1 min)、C组(出生后2 min)、D组(出生后3 min)及E组(脐动脉搏动消失组),比较各组间新生儿出生后的脐血血气分析、出生后前10 min的脉氧饱和度、出生后3 d的血常规及出生3 d的胆红素值的差异。结果不同断脐时间下新生儿脐血血气分析各项指标(pH、HCO 3、-HB、SO 2)比较差异无统计学意义(P<0.05);不同断脐时间下新生儿出生第3天的HB结果差异无统计学意义(P>0.05);D组相比较于B组、C组出生后第3天的HCT结果差异有统计学意义(P<0.05);D组相比较于B组第1天黄疸值差异有统计学意义(P<0.05);D组相比较于C组第2天黄疸值差异有统计学意义(P<0.05);C组和D组相比较于A组和B组,第1、2 min脉氧饱和度差异有统计学意义(P<0.05)。结论随着断脐时间的增加,可以预防新生儿贫血的发生,增加新生儿出生过渡期的心血管稳定性,进一步降低近远期并发生的发生率;但是否会增加新生儿病理性黄疸和需要光疗治疗的黄疸发生率,仍待进一步数据的验证。

Objective To analyze the effect of delayed umbilical cord ligation on term newborns,and to provide theoretical data support for the implementation of delayed umbilical cord ligation in clinical practice.Methods Eighty pregnant women and their newborns were enrolled in the Yan′an University Affiliated Hospital from June 2019 to September 2019.According to the time from the complete delivery of the newborn to the umbilical cord clamping,it was divided into five groups(immediately umbilical cordclamping,1 minute after birth,2 minutes after birth,3 minutes after birth,and umbilical artery pulsation disappeared group),and comparison of umbilical cord blood gas analysis after neonatal birth,pulse oxygen saturation in the first 10 minutes after birth,blood routine at 3 days after birth,and bilirubin value at 3 days after birth between each group.Results There were no significant differences in the umbilical cord blood gas analysis(pH,HCO 3,-HB,SO 2)(P<0.05).There was no significant difference in HB results on the third day of birth between different umbilical cords(P>0.05).The difference of HCT results at 3 minutes compared with 1 minute and 2 minutes after birth was statistically significant(P<0.05);The umbilical cord time is 3 minutes compared to 1 minute,the difference in jaundice on the first day of the former group than the latter group was statistically significant( P <0.05);the umbilical cord was 3 minutes compared with the 2nd day of the umbilical cord on the 2nd day,the difference was statistically significant( P <0.05);There was a statistically significant difference in pulse oxygen saturation between the 1st and 2nd minute of the umbilical cord at 2 and 3 minutes compared with the immediate umbilical cord and 1 minute of umbilical cord injury( P <0.05). Conclusion With the increase of umbilical cord time,it can prevent the occurrence of anemia in neonates,increase the cardiovascular stability during the neonatal birth transition period,and further reduce the incidence of recent and long-term occurrence;but whether it will increase neonatal pathological jaundice The incidence of jaundice and phototherapy needs to be verified by further data.